دورية أكاديمية
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Characteristics and Predictors of Late Right Heart Failure After Left Ventricular Assist Device Implantation.

التفاصيل البيبلوغرافية
العنوان: Characteristics and Predictors of Late Right Heart Failure After Left Ventricular Assist Device Implantation.
المؤلفون: Alkhunaizi FA; From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland., Azih NI; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina., Read JM; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina., Goldberg RL; From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland., Gulati AA; From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland., Scheel PJ 3rd; From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland., Muslem R; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands., Gilotra NA; From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland., Sharma K; From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland., Kilic A; Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland., Houston BA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina., Tedford RJ; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina., Hsu S; From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
المصدر: ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2023 Mar 01; Vol. 69 (3), pp. 315-323. Date of Electronic Publication: 2022 Oct 02.
نوع المنشور: Multicenter Study; Journal Article; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 9204109 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1538-943X (Electronic) Linking ISSN: 10582916 NLM ISO Abbreviation: ASAIO J Subsets: MEDLINE
أسماء مطبوعة: Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Philadelphia, PA : Published for the Society by J.B. Lippincott Co., c1992-
مواضيع طبية MeSH: Heart-Assist Devices*/adverse effects , Heart Failure*/complications , Ventricular Dysfunction, Right*, Adult ; Humans ; Retrospective Studies ; Pulmonary Wedge Pressure ; Risk Factors ; Treatment Outcome
مستخلص: Late right heart failure (LRHF) following left ventricular assist device (LVAD) implantation remains poorly characterized and challenging to predict. We performed a multicenter retrospective study of LRHF in 237 consecutive adult LVAD patients, in which LRHF was defined according to the 2020 Mechanical Circulatory Support Academic Research Consortium guidelines. Clinical and hemodynamic variables were assessed pre- and post-implant. Competing-risk regression and Kaplan-Meier survival analysis were used to assess outcomes. LRHF prediction was assessed using multivariable logistic and Cox proportional hazards regression. Among 237 LVAD patients, 45 (19%) developed LRHF at a median of 133 days post-LVAD. LRHF patients had more frequent heart failure hospitalizations ( p < 0.001) alongside other complications. LRHF patients did not experience reduced bridge-to-transplant rates but did suffer increased mortality (hazard ratio 1.95, 95% confidence interval [CI] 1.11-3.42; p = 0.02). Hemodynamically, LRHF patients demonstrated higher right atrial pressure, mean pulmonary arterial pressure, and pulmonary vascular resistance (PVR), but no difference in pulmonary arterial wedge pressure. History of early right heart failure, blood urea nitrogen (BUN) > 35 mg/dl at 1 month post-LVAD, and diuretic requirements at 1 month post-LVAD were each significant, independent predictors of LRHF in multivariable analysis. An LRHF prediction risk score incorporating these variables predicted LRHF with excellent discrimination (log-rank p < 0.0001). Overall, LRHF post-LVAD is more common than generally appreciated, with significant morbidity and mortality. Elevated PVR and precapillary pulmonary pressures may play a role. A risk score using early right heart failure, elevated BUN, and diuretic requirements 1 month post implant predicted the development of LRHF.
Competing Interests: Disclosure: R.T. reports general disclosures to include consulting relationships with Medtronic, Abbott, Aria CV Inc., Acceleron, Itamar, Edwards LifeSciences, Eidos Therapeutics, Lexicon Pharmaceuticals, Gradient and United Therapeutics. He is on a steering committee for Medtronic, Acceleron, and Abbott as well as on a research advisory board for Abiomed. He also does hemodynamic core lab work for Actelion and Merck. The other authors have no conflicts of interest to report..
(Copyright © ASAIO 2022.)
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معلومات مُعتمدة: K23 HL146889 United States HL NHLBI NIH HHS; R01 HL114910 United States HL NHLBI NIH HHS
تواريخ الأحداث: Date Created: 20221003 Date Completed: 20230301 Latest Revision: 20240301
رمز التحديث: 20240301
مُعرف محوري في PubMed: PMC10901567
DOI: 10.1097/MAT.0000000000001804
PMID: 36191552
قاعدة البيانات: MEDLINE
الوصف
تدمد:1538-943X
DOI:10.1097/MAT.0000000000001804